G’day everyone and welcome to another blog, it’s been a while from me. To get the ball rolling again, this blog will revisit one of the most common presentations that first responders will encounter – chest pain! And with that, the ANZCOR guidelines have now given us the nod to give some medication that will […] The post First Aid for Heart Attacks appeared first on Paradise First Aid.
G’day everyone and welcome to another blog, it’s been a while from me. To get the ball rolling again, this blog will revisit one of the most common presentations that first responders will encounter – chest pain! And with that, the ANZCOR guidelines have now given us the nod to give some medication that will greatly help out with this, especially if the person is having a heart attack. So, let’s take a look behind the rib cage and see what we can see.
What is a ‘textbook heart attack’?
You are the first aider at a sports event. A slightly overweight 50-something-year-old man walks over to you, holding on to the middle of his chest. He’s sweating a lot, is very pale, and seems to be quite out of breath. He tells you he feels really nauseous, like he’s got bad indigestion that just won’t go away. Being a good first aider, this rings some alarm bells. You probe some more and discover that he’s holding his chest because he tells you it’s really quite painful, like an elephant sitting on the middle of his chest. That pain, weirdly, feels like it’s going up into his neck and down his arm. It just came on all of a sudden and won’t go away.
This is a classic case of someone having a suspected heart attack. The risk factors are there – older population and overweight. Instead of pain, it might be described as ‘discomfort’, ‘pressure’, or ‘tightness’. The referred pain may go into the stomach, between the shoulder blades, into the neck, jaw or teeth. There may also be a sense of impending doom. Careful though, because some folk (women, elderly, folk with diabetes, congestive cardiac disease or kidney failure) may present differently. I’ve had patients who said ‘I just don’t feel right’ and they’ve been having a heart attack. So good solid questioning, good history and listening to your spidey senses that ‘something’s not quite right’ and you can’t go wrong. If in doubt, there is no doubt, call Triple Zero. So, what is a heart attack then?
Acute Coronary Syndrome (ACS)
Acute Coronary Syndrome is a bunch of conditions that result in myocardial ischaemia. This is the technical term for death/damage to the heart muscle. It encompasses ST-elevation myocardial infarction (STEMI, can be diagnosed using an ECG); non-ST elevation myocardial infarction (NSTEMI, diagnosed doing a blood test to measure the amount of Troponin enzyme in your blood. Troponin is the enzyme released when the cardiac muscle dies); and unstable angina (UA). Now, stable angina doesn’t come into play here as this one is clearly exacerbated by exertion/stress and is quickly resolved with the tablet/spray under the tongue, or by rest. UA isn’t, it sticks around. These are the medical terms that, broadly speaking, are what folk are referring to when they say they have a ‘heart attack’. So what does all this actually mean in layman’s terms?
Three Actions of the Heart
The simplest way I teach a heart attack is to break it down into the three ‘actions’ of the heart – plumbing, electrical and mechanical/structural. The plumbing part refers to the coronary blood vessels, those very important pipes that supply blood to the heart muscle. Those bad boys rely on an uninterrupted supply of blood to keep that heart muscle healthy. However, a solid diet of KFC, Winfield Blues and Toohey’s New can lead to some blockages in the pipes. These blockages, known as atherosclerosis (which is a build up of fatty plaque) make the inner linings of the pipes restricted. With exertion, increased flow of blood becomes restricted and causes pain in the chest (Angina). Stop the exertion and perhaps take some medication (GTN under the tongue, for example) and the pain goes away, you have Stable Angina. If it hangs around, you have Unstable Angina. People diagnosed with this will likely tell you they ‘have a stent’ or have ‘had a bypass’. It tends to resolve the problem and they may not necessarily have had a full blown ‘heart attack’ to get these procedures. Left alone, chances are strong they would have! Sometimes though, that plaque build up breaks away and you end up with what’s called a thrombus (or a clot). This can then completely block the pipe, which stops supply of blood to the heart muscle, which causes it to die. This can lead to potentially much badness for the patient.
The electrical component is a whole text book in itself. To keep it simple, think of getting zapped by electricity. What happens to your muscles? They contract. The cool thing about the heart, is that it creates its own electrical shocks. Travelling through the walls of the heart muscle, it starts at the top of the heart, spreads out around the top, moves down the middle and spreads out around the bottom. This causes the top of the heart to contract (the atria), followed by the bottom part (the ventricles). End result, the heart squeezes and blood gets pumped around the heart, to the lungs and to the rest of the body. Now, if this power supply is disrupted (by a blockage in the coronary vessels causing the heart muscle to die), it can be seen by paramedics, nurses or doctors on the ECG. It’s pretty obvious if you’ve been trained in ECG interpretation and is what is known as a STEMI (the ST component of the ECG is elevated and you’re having a heart attack, or myocardial infarction. Hence ST Elevated Myocardial Infarction). You’re having a bad day if this happens to you, but on the plus side, the people who found it have solid training on what to do next!!! The really bad thing about the electrical activity being disrupted is that it can then degenerate into funky electrical patterns like Ventricular Tachycardia and Ventricular Fibrillation. Cast your minds back to your CPR course and you’ll know that these two rhythms are bad – these are the ones we can shock with a defibrillator and you’re in cardiac arrest. NOT TO BE CONFUSED WITH A HEART ATTACK THOUGH!!!!
Finally, the mechanical/structural actions of the heart refer to the heart muscle itself and the valves. If things go wrong here, it can result in dramas. It is the death of the heart muscle (structure) that causes the release of that troponin enzyme that can be detected in blood tests and definitively show you’re having a heart attack (NSTEMI). It can also muck around with the electrical activity of your heart (STEMI) as mentioned before. All three combined generally result in a heart attack and that’s why it’s good to know the background of how it happens, especially if you’re a trainer explaining it to your students.
Can First Aid Help?
So really, what can we, as first aiders, actually do for our patients? The short answer is quite a bit! First thing, a heart attack is a time-critical event. The longer you wait, the more of the heart muscle is damaged. So early recognition is crucial, which will (hopefully!!!) prompt you to call Triple Zero and get an ambulance out ASAP. The paramedics can then do some very cool paramedic stuff and help the patient out a lot, before taking them to hospital and, if the circumstances are right, to a cardiac catheter lab where some even cooler interventional procedures can happen to greatly enhance the survivability of your patient. Seriously, jump on YouTube and have a search for cardiac stents or coronary angiography. Fascinating!!!
Whilst waiting for the ambos, we can get our patient to sit down and rest. Exertion causes the heart to pump harder and consequently, those narrow or blocked blood vessels will cause more pain. So, kick back, try to relax and don’t do anything strenuous. Get your patient to do the same! Ask the patient if they have any medication. They may have been diagnosed with angina, so they could have a tablet that goes under their tongue. Help them take it. They might also have a spray that does the same. Again, assist them with it. No, don’t randomly give someone else’s medication to a person just because they have the same symptoms!!! As first aiders, we can assist in giving medicines that are prescribed to that person. No sharing!!!
Giving Asprin
Finally, we can give aspirin. This is a drug a first aider is allowed to give expressively to manage a suspected heart attack. Acetylsalicylic acid (ASA), or, more commonly, Aspirin, is an antiplatelet drug. Now, there is a bit of confusion as to what that actually is, and collectively, it is often referred to as ‘blood thinners’. So…
Anticoagulants – are drugs that slow down the process in the body of forming clots. Drugs such as heparin or warfarin.
Antiplatelet – drugs that prevent cells currently in the blood, called platelets, from clumping. Drugs such as Aspirin or Clopidogrel fall in here
Platelets (also known as thrombocytes) are the cells in our blood responsible for forming clots. I won’t get into the nitty-gritty of how that happens; suffice to say that essentially, if you get a cut, the platelets are responsible for building the framework at the opening of the wound to form a clot or scab, and bleeding stops. Remove the ability to make a clot (see above re ‘blood thinners) and you’ll keep bleeding. So, blood thinners can be both good and bad in first aid! For a heart attack, it’s good!!! As mentioned earlier, a clot, or ‘thrombus’, forms inside the coronary blood vessel (thrombosis). To prevent further build-up of the clot, we give Aspirin. Within about 10 minutes, the Aspirin is working its magic and the platelets lose their ability to adhere to the pre-existing clot. When teaching, I tend to describe it as similar to putting a Teflon coating on the platelets, allowing them to slide past the clot and not make it bigger (and likely much worse for the patient).
And that’s about all there is to it. Heart attacks are very survivable yet very common. According to the Heart Research Institute, almost half a million Australians have had a heart attack, and over 50,000 a year have one. The older you get, the higher the risk and fellas, we’re twice as likely as the fairer sex to have one. Manage some of the risk factors though (overweight, high blood pressure, high cholesterol, smoking, inactivity and diabetes) and you’ll give yourself a better shot. Do a first aid course and get, at a minimum, your CPR skills updated.
In summary
- Acute Coronary Syndrome is the correct term for heart attack – STEMI, NSTEMI and Unstable Angina
- Recognised by:
- Central chest pain, described as heavy, crushing, tight, uncomfortable
- Radiating pain to the arms, shoulders, neck, jaw, teeth, back, stomach
- Short of breath
- Sweating
- Sense of impending doom
- The feeling of ‘indigestion’
- Dizziness, lightheadedness
- Nausea and/or vomiting
- Managed by:
- Triple Zero (000)
- Stop all activity and rest
- Assist with own medications
- Administer aspirin (300mg)
- If resources permit, locate an AED
Thanks for reading folks, don’t hesitate to reach out if you have any questions or suggestions for future blogs. As always, Paradise First Aid offer the full suite of first aid courses by excellent trainers either in our own training rooms or in your workplace. Stay safe.
References used:
ANZCOR Guideline 9.2.1 Recognition and First Aid Management of Suspected Heart Attack
QAS Clinical Practice Manual
Heart Research Institute – https://www.hri.org.au/
Medline Plus
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